Influence of spontaneous splenorenal shunts on clinical outcomes in decompensated cirrhosis and after liver transplantation

Saks, Karen; Jensen, Kyle K.; McLouth, Joel; Hum, Justine; Ahn, Joseph; Zaman, Atif; Chang, Michael; Fung, A.; Schlansky, Barry

doi:10.1002/hep4.1157

Cited by 21 publications

(24 citation statements)

References 21 publications

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“… 48 The left renal vein is frequently involved in portosystemic collateral drainage: splenorenal (10–23%) and gastrorenal shunts (5–11%) were also frequently described. 28 , 32 , 40 , 42 – 44 By contrast, splenorenal shunt was the most frequent large SPSS found in the Baveno VI Cooperation Group cohort. 25 Mesenteric collaterals from superior and inferior mesenteric veins are also present in many series in a lower percentage.…”

Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 84%

“…33 Many studies have evaluated the type of shunt detected, 25,[27][28][29]32,35,43 and most of them have focused on the identification of a specific type of SPSS (Table 1). 30,31,[36][37][38][39][40][41][42]44,46 Paraumbilical vein shunt was the most frequently reported SPSS, found in up to 43% of patients 30,31,[35][36][37][38]47 and even 59% when combined with other SPSSs. 39 Despite the high prevalence, its classical advanced form as caput medusa is rarely seen.…”

Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 99%

“… 40 Finally, Saks et al identified a higher percentage of EVs, but a lower probability of ascites. 44 …”

Section: Clinical Studies and Complications Related To Spssmentioning

confidence: 99%

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Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

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Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 84%

Section: Spss Prevalence In Liver Cirrhosismentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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“…Multiple variables, such as the type of immunosuppression, infection prophylaxis, postoperative complications as well as biliary and vascular complications, are some of the known factors that we monitor closely in the postoperative setting . Because of the remarkable clinical impact that SPSSs can have in the pre‐LT population, we wanted to study the potential impact of SPSSs in post‐LT patients because data in the post‐LT setting are limited . The aim of the present study was to evaluate the impact of pre‐LT SPSSs on overall survival and graft survival in the post‐LT setting.…”

mentioning

confidence: 99%

Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

et al. 2020

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Spontaneous portosystemic shunts (SPSSs) have been associated with worse clinical outcomes in the pre-liver transplantation (LT) setting, but little is known about their post-LT impacts. Our aim was to compare LT candidates with and withoutSPSSs and assess the impact of SPSSs on patient mortality and graft survival in the post-LT setting. Patients 18 years or older with abdominal imaging done prior to LT were included. Exclusion criteria were the presence of pre-LT surgical shunts, LT indications other than cirrhosis, and combined solid organ transplantations. SPSSs were classified as absent, small, or large according to their maximum diameter (8 mm). Multiple variables that could influence the post-LT course were extracted for analysis. Patient and graft survival were estimated using the Kaplan-Meier method and were compared between groups using a log-rank test. The project received institutional review board approval. We extracted data from 326 patients. After comparing patients without SPSS or with small or large SPSSs, no statistical difference was found for overall patient survival: no SPSS (n = 8/63), reference; small SPSS (n = 18/150), hazard ratio (HR), 1.05 (95% confidence interval [CI], 0.45-2.46); and large SPSS (n = 6/113), HR, 0.60 (95% CI, 0.20-1.78); P = 0.20. Also, no difference was found for graft survival: no SPSS (n = 11/63), reference; small SPSS (n = 21/150), HR, 0.80 (95% CI, 0.38-1.70); large SPSS (n = 11/113), HR, 0.59 (95% CI, 0.25-1.40); P = 0.48. Similarly, no statistical significance was found for these variables when comparing if the graft used was procured from a donation after circulatory death donor versus a donation after brain death donor. In conclusion, the previously described association between SPSSs and worse clinical outcomes in pre-LT patients seems not to persist once patients undergo LT. This study suggests that no steps to correct SPSS intraoperatively are necessary. Liver Transplantation 26 693-701 2020 AASLD.Portal hypertension is defined by a hepatic venous pressure gradient of 6 mmHg or more, and in the clinical scenario of cirrhosis, it is characterized by complications, such as ascites, variceal bleeding, and hepatic encephalopathy in advanced cases. (1) In cirrhosis, portal hypertension results from the increased collagen deposition and formation of regenerative nodules, which eventually lead to an increase in portal pressure. (2) These changes are followed by compensatory splanchnic vasodilation, which will further increase portal flow and continue to worsen portal pressure (as predicted by Ohm's law). The presence of these complications leads to clinical deterioration, with some series describing up to 80% 5-year mortality if 2 complications were present concomitantly, (3) which also results in cost increases due to frequent hospital admissions. (4) A complication in the setting of portal hypertension is the formation of spontaneous portosystemic shunts (SPSSs). These are channels that form as the portal rOdriguez et al.

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“…However, portal hypertension-related hemorrhage occurred in 46% of patients with any shunt (large or small) vs no shunt. These data may point toward an important clinical relevance that favors PS as a surrogate for severe and worsening portal hypertension 15. The presence of ascites was less likely to occur in patients with cirrhosis and large PS and HE in a retrospective study 11.…”

Section: Clinical Relevance Of Pss In Cirrhosismentioning

confidence: 84%

<p>Portosystemic shunts and refractory hepatic encephalopathy: patient selection and current options</p>

Philips¹,

Rajesh²,

Augustine³

et al. 2019

HMER

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Portosystemic shunt (PS) syndrome encompasses a spectrum of disease manifestations ranging from asymptomatic portal hypertension to recurrent and refractory hepatic encephalopathy, ultimately culminating in progressive hepatic failure in patients of cirrhosis and associated large PSs. PSs commonly seen in cirrhosis include splenorenal, gastrorenal, and dilated paraumbilical veins, all of which can present with recurrent or refractory hepatic encephalopathy. In this exhaustive review, we describe the anatomy of PSs, elucidate new theories on their pathophysiology, discuss the clinical implications of PSs in cirrhosis, provide details on different techniques (classical and novel) of shunt embolization, and explore all the pertinent current literature on shunt embolization for refractory and recurrent hepatic encephalopathy, all of which are enumerated with extensive images and illustrations.

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Influence of spontaneous splenorenal shunts on clinical outcomes in decompensated cirrhosis and after liver transplantation

Cited by 21 publications

References 21 publications

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Clinical Outcomes of Portosystemic Shunts on the Outcome of Liver Transplantation

<p>Portosystemic shunts and refractory hepatic encephalopathy: patient selection and current options</p>

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